Countdown to 2030: Lancet report demands new momentum for health SDG

The latest Lancet Countdown to 2030 report calls for picking up the pace in reaching UN Sustainable Development Goal (SDG) 3 for health and health-related targets. Although most indicators show progress, the report cautions that improvement rates have slowed since 2015, “falling well short of the pace needed to achieve” women’s, children’s, and adolescents’ health and nutrition targets. 

The UN’s SDG 3 calls for ensuring healthy lives and promoting well-being for all at all ages. 

The report authors note that the deceleration in progress contrasts the aspired convergence in health that was expected from 2015 onward, based on the assumption that the “spectacular progress” achieved during the UN Millennium Development Goals (2000–2015) would continue. 

“We hope that this report’s analyses will fuel dialogue and action needed to ensure acceleration of progress in women’s, children’s, and adolescents’ health,” reads the report. 

It examines global and regional trends and inequalities in health determinants, survival, nutritional status, intervention coverage, and quality of care in reproductive, maternal, newborn, child, and adolescent health and nutrition. 

The study also reviews country health systems, policies, financing, and prioritization, with a focus on low- and middle-income countries where 99% of maternal and 98% of child and adolescent deaths occur. 

The report flags multiple external and internal threats to accelerate progress. Its authors call to prioritize West and Central Africa as it finds a large and persistent gap in reaching many indicators in sub-Saharan Africa compared to other parts of the world.

Prioritizing sub-Saharan Africa

The report authors make five key recommendations to accelerate the achievement of SDG 3: an explicit focus on sub-Saharan Africa; strengthening health systems for reproductive, maternal, newborn, child, and adolescent health and nutrition; safeguarding progress against crises; monitoring and accountability; and revitalizing reproductive, maternal, newborn, child, and adolescent health and nutrition. 

The paper calls for a “major initiative led by regional institutions and countries with strong global support” in sub-Saharan Africa, as economic challenges, armed conflict, and food insecurity are disproportionately concentrated in this region. West and Central Africa lag in “nearly all indicators.” 

The authors stress the importance of increasing financing, from domestic sources and external donors, to strengthen health systems in lower- and middle-income countries. The team calls for prioritizing strategies for improving working density and distribution, protecting country health budgets, innovating in commodities and service delivery, and improving quality of care. 

The report calls to strengthen health systems and prioritize reproductive, maternal, newborn, child, and adolescent health and nutrition.They add: “The most pressing need is for action that safeguards health, education, and social protection services for women, children, and adolescents in countries affected by economic downturns and debt servicing agreements and disasters related to conflict, environmental change, and epidemics.”

The report identifies “major data gaps,” which is why the authors call for data-driven accountability for all stakeholders. They say overcoming these gaps requires sustained global and country-level investments in health information systems and methodological innovations. 

“Enhanced global coordination and compelling ideas about why women, children, and adolescents should remain at the core of health and development agendas are needed to drive collective action and sustain progress,” reads the report. 

The authors recommend building a narrative to show why providing this group of people with high-quality services is central to emerging global priorities. This includes achieving universal health coverage and preventing non-communicable diseases. 

Dialogues on other global issues, such as climate change, should also prioritize the health and nutrition of these population groups and their long-term effects. 

Challenges to reaching health goals

According to the Lancet report, the global health and development agenda faces significant obstacles. It points to economic trends, such as slower economic growth, stagnating poverty reduction, and a considerable debt crisis, and says that education and gender equity improvements have slowed since 2015. 

The authors also note that more countries have been affected by armed conflicts compared with ten years ago, and food insecurity has risen during the SDG period. Moreover, climate change and its consequences in extreme weather events, food insecurity, diseases, and infrastructure pose severe threats to women’s, children’s, and adolescents’ health. 

“These crises and challenges are exacerbated by, and often contribute to, vast inequalities between and within countries,” state the authors. “Women, children, and adolescents living in the least favorable social and economic environments, where multiple dimensions of inequality intersect, are the most vulnerable to the consequences of these challenges.”

The authors call to prioritize sub-Saharan Africa due to the region’s gap in reaching many indicators for health SDGs.Moreover, the report flags decreased prioritization and funding for reproductive, maternal, newborn, child, and adolescent health and nutrition. The authors link this development to a shift in funding toward pandemic response in 2020–2021, as well as a broader landscape of fiscal constraints, climate change, the wars in Ukraine and Gaza, and a waning commitment to multilateralism. 

They explain that an absence of a “compelling unified framing” has fragmented the child and women’s health and led to less collaboration to support continuous care. 

Coverage inequalities expand

Although upper-middle-income countries have achieved SDG targets on maternal and child mortality, progress in lower- and middle-income countries is “far below the pace needed to achieve the SDGs,” finds the report. 

Undernutrition has declined in most regions and country income groups at a similar rate as during 2000–2015. However, most countries are not on pace to achieve the SDG targets. Moreover, obesity rates in women and individuals aged 5–19 has increased rapidly since 2015. 

Progress in essential intervention coverage has been uneven and slowed since 2015, especially in Eastern and Southern Africa. Although inequalities in poor and rich households have narrowed, the report stresses significant subnational coverage inequalities.

The report notes that adoption of human-rights-based policies is not universal across low- and middle-income countries. Policies do not always reflect a prioritization of reproductive, maternal, newborn, child, and adolescent health and nutrition or a commitment to protect the human right to health. 

Moreover, indicators of health financing, workforce, and information systems show insufficient progress in strengthening the health system. 

Finally, the report flags that demographic and epidemiological transitions in lower- and middle-income countries may impact their health systems. 

For example, sub-Saharan African countries, where over half the population is younger than 20 years and fertility remains high, have added pressure to support their health systems to meet growing demands. However, strengthening these systems is challenging, as macroeconomic developments affect countries’ health budgets.